Glaucoma Treatment Options
What Is Glaucoma, and How Can It Be Treated?
What Is Glaucoma?
Glaucoma is an eye disease in which increased pressure in your eye or eyes causes damage to the optic nerve. It can be a scary diagnosis, as the damage done by glaucoma can’t be reversed. Sufferers will need some kind of treatment for the rest of their lives.
What Are the Symptoms of Glaucoma?
There are two kinds of glaucoma. Open-angle glaucoma, which is caused by a partial blockage of the normal drainage of fluid from the eye, causes patchy blind spots and advances to tunnel vision; that is to say, significant loss of peripheral vision. Angle-closure glaucoma causes headaches, pain in the eyes, nausea, and vomiting, blurred vision, and halos around lights. These symptoms can sometimes be mistaken for migraine. The eyes may also become red. These symptoms coming on suddenly are a medical emergency. If you have them and have no history of migraine, you should go to the ER.
Glaucoma tends to run in families. Glaucoma treatment generally includes medications and possibly surgery.
How Will the Doctor Diagnose Glaucoma?
The primary test for glaucoma risk has the fancy name of tonometry. One form of tonometry is the test the eye doctor does where you look into a device and a puff of air is pushed into your eyes. This test gives the doctor a quick idea as to whether your eye pressure is high and further testing is needed. Tonometry is a basic screening test, however, and on its own is not sufficient for a diagnosis. If this test shows high pressure, the doctor may order a more sensitive form of tonometry in which they numb your eyes with eye drops and gently touch your cornea with a tonometer.
To finalize a diagnosis, the doctor will also look inside your eye with a magnifying lens, use a test called a gonioscope to examine the angle between the cornea and iris (this helps determine what kind of glaucoma you have), and do a visual field test to look for vision damage.
What Is the First Line of Treatment?
You might have heard that glaucoma is treated with surgery. This is true, but except for acute angle-closure glaucoma, surgery is not the first resort. Instead, most patients are prescribed eye drops that either decrease the amount of fluid produced in your eyes or improve drainage, depending. In some cases, you might have to use more than one eye drop or try different ones to get a good result. Here are the eye drops that are generally used.
To Reduce Fluid Production
Beta-blockers. Not quite the same thing as the psych medication. They are reasonably inexpensive but can have systemic side effects if the eye is not closed right after application. Side effects can include difficulty breathing, slowed heart rate, lower blood pressure, fatigue, and erectile dysfunction.
Carbonic anhydrase inhibitors. Generally used if you can’t tolerate beta blockers. They can also have systemic side effects, including frequent urination and tingling in the fingers and toes.
Rho kinase inhibitor. This medication suppresses the enzymes that produce fluids. Side effects can include redness and discomfort in the eye.
To Improve Drainage
Prostaglandins. This is generally the medication your eye doctor will try first, as it’s well tolerated by most, although it can cause your eye color to change (yes, it really can) by darkening the iris or the pigment of the eyelashes. It can cause some eye discomfort. There are multiple preparations, and your eye doctor may try more than one to get the best results.
Miotic or cholinergic agents. These are rarely prescribed, as you have to use them up to four times a day and they have a tendency to cause nearsightedness as well as headaches. In general, these are only prescribed if other medications are not working.
To Do Both
Alpha-adrenergic agonists. This drug has both effects but is another one that can cause systemic effects, including irregular heart rate, high blood pressure, and fatigue.
For most patients, prostaglandins, beta-blockers, or both will be prescribed. If you receive eye drops, you should close your eyes for one to two minutes after putting the drops in and press lightly at the inner corner of your eyes to close the tear duct. Also, apply multiple eye drops at least five minutes apart.
If eye drops alone are not working, the doctor might also give you an oral carbonic anhydrase inhibitor. Be aware that this medication can cause depression.
Not every patient will end up needing surgery. For those that do, there are a number of procedures that might be recommended. Some of these surgical treatments can be done in the ophthalmologist’s office, especially if you are already seeing a glaucoma specialist. For others, you might have to go to the hospital.